Oral health awareness and care preferences in patients with diabetes: a qualitative study

BACKGROUND

People with type 2 diabetes have an increased risk of oral health problems; however, oral health is currently not included in structured diabetes reviews and education in the UK.

AIM AND OBJECTIVES

This study explores the patient's experience related to oral health and diabetes, especially in relation to: • Awareness of the link between oral health and diabetes and oral self-care needs. • Interaction with health professionals in dental and general practice. • Preferences for receiving oral health information and education. Methods This nested qualitative study involved semi-structured telephone interviews with a purposive sample of 20 participants from a questionnaire study on oral health awareness in patients with diabetes. Interview transcripts were analysed using a thematic framework approach.

RESULTS

Participants were mostly unaware of the link between oral health and diabetes. Those that had been made aware by a health professional were not given concrete self-care advice. Interactions with dental professionals were often limited to informing the dental practice of their diagnosis and current medication. Most participants were in favour of dentists screening for diabetes, but as their general practice was the hub for diabetes care, they felt GPs or nurses should provide oral health information and discuss oral health with patients.

CONCLUSIONS

Written information regarding diabetes and its possible effects on oral health needs to be more readily available to people with diabetes, especially at diagnosis. There may be a place for introducing a structured oral health question in routine diabetes reviews.

An integrated cancer biomarker information system

Rapid progress in functional genomics is yielding unparalleled opportunities for cancer biomarker discovery. Several procedures including data collection, analysis, verification, and visualization are necessary to identify cancer biomarkers from continuously updated microarray data, which are derived from multiple tissue sources using various methods. BioMarker is designed to integrate these procedures in a user-friendly manner, for practical application by cancer researcher and clinicians. From the feedback of clinical and research application, BioMarker is the first effort to provide a system that facilitates all aspects of biomarker discovery from microarray datasets.

PAR(2) expression in peripheral blood monocytes of patients with rheumatoid arthritis

OBJECTIVES

Proteinase-activated receptor 2 (PAR(2)) is a G protein-coupled receptor activated by serine proteinases with proinflammatory activity. A study was undertaken to investigate the presence and functional significance of PAR(2) expression on rheumatoid arthritis (RA)-derived leucocyte subsets.

METHODS

Venous blood was obtained from patients with RA and osteoarthritis (OA) as well as healthy control subjects. Surface expression of PAR(2) on peripheral blood mononuclear cells (PBMCs) was analysed by flow cytometry and interleukin 6 (IL-6) generation by ELISA.

RESULTS

Patients with RA had elevated but variable surface expression of PAR(2) on CD14+ monocytes compared with control subjects (median (1st to 3rd quartiles) 1.76% (0.86-4.10%) vs 0.06% (0.03-0.81%), p<0.0001). CD3+ T cells showed a similar pattern with significantly higher PAR(2) expression in patients with RA compared with controls (3.05% (0.36-11.82%) vs 0.08% (0.02-0.28%), p<0.0001). For both subsets, PAR(2) expression was significantly higher (p<0.00001) in patients with high levels of disease activity: PAR(2) expression for both CD14+ and CD3+ cells correlated to C reactive protein and erythrocyte sedimentation rate. Furthermore, in a cohort of patients with newly diagnosed RA, elevated PAR(2) expression in both CD14+ and CD3+ cells was significantly reduced 3 months after methotrexate or sulfasalazine treatment and this reduction correlated significantly with the reduction in the 28-joint Disease Activity Scale score (p<0.05). PAR(2) expression on cells from patients with OA was low, similar to levels seen in control subjects. Generation of IL-6 by monocytes in response to a selective PAR(2) agonist was significantly greater in patients with RA than in patients with OA and control subjects (p<0.05).

CONCLUSIONS

These findings are consistent with a pathogenic role for PAR(2) in RA.

Candidate genes for carotenoid coloration in vertebrates and their expression profiles in the carotenoid-containing plumage and bill of a wild bird

Carotenoid-based coloration has attracted much attention in evolutionary biology owing to its role in honest, condition-dependent signalling. Knowledge of the genetic pathways that regulate carotenoid coloration is crucial for an understanding of any trade-offs involved. We identified genes with potential roles in carotenoid coloration in vertebrates via (i) carotenoid uptake (SR-BI, CD36), (ii) binding and deposition (StAR1, MLN64, StAR4, StAR5, APOD, PLIN, GSTA2), and (iii) breakdown (BCO2, BCMO1). We examined the expression of these candidate loci in carotenoid-coloured tissues and several control tissues of the red-billed quelea (Quelea quelea), a species that exhibits a male breeding plumage colour polymorphism and sexually dimorphic variation in bill colour. All of the candidate genes except StAR1 were expressed in both the plumage and bill of queleas, indicating a potential role in carotenoid coloration in the quelea. However, no differences in the relative expression of any of the genes were found among the quelea carotenoid phenotypes, suggesting that other genes control the polymorphic and sexually dimorphic variation in carotenoid coloration observed in this species. Our identification of a number of potential carotenoid genes in different functional categories provides a critical starting point for future work on carotenoid colour regulation in vertebrate taxa.

'It don't make sense to worry too much': the experience of prostate cancer in African-Caribbean men in the UK

The incidence of prostate cancer among African-Caribbean men in the UK is three times that among men from the majority population. Little attention, however, has been given to the perceptions and experiences of treatment and care of men from these communities with prostate cancer. This qualitative study is the first such investigation, situating men's accounts within the context of their personal history and social environment. Using a community-based, snowball sampling method, 16 first generation African-Caribbean men living in Central England were recruited. Similarities and divergence in men's experience were identified through thematic analysis of interview transcripts. Men's responses to their situation were influenced by aspects of migration and historical context as well as culture. While medical treatment was highly valued, common difficulties were compounded by problems of health professional-patient communication, stereotyping and insensitivity of some staff. Lack of coordination between services and agencies adversely affected the well-being of frail men and widowers. Findings suggest the need for a more proactive approach to giving and eliciting information combined with cultural diversity training. More systematic referral procedures and information exchange between African-Caribbean men with prostate cancer and their general practitioner, hospital, social care and voluntary agencies, churches and community organisations are indicated.

Neurotropism in blackcaps (Sylvia atricapilla) and red-billed queleas (Quelea quelea) after highly pathogenic avian influenza virus H5N1 infection

The epidemiologic role of passerine birds in the spread of highly pathogenic avian influenza virus (HPAIV) remains controversial. However, confirmed natural infections with HPAIV in Passeriformes, their close contact to poultry and humans, and their role as a human food source indicate a need for increased research on passerines. To date, there are only a few studies on viral shedding and pathomorphologic changes in songbirds infected with HPAIV. To investigate susceptibility, clinical outcome, virus spread, and pathomorphology, the authors inoculated oculo-oronasally 22 red-billed queleas (Quelea quelea) and 11 blackcaps (Sylvia atricapilla) with A/Cygnus cygnus/Germany/R65/2006 (H5N1) using 2 different doses of either 10(4) EID50 (50% egg infective dose) or 10(6) EID50 per animal. They monitored all birds for clinical signs and oropharyngeal and cloacal virus shedding. They also performed immunohistochemistry and obtained molecular virologic data by real-time reverse transcription polymerase chain reaction in tissue samples. In contrast to blackcaps, where 100% of the infected individuals died, queleas were much less susceptible, with a mortality of 82% and 18%, depending on the doses applied. In both species, the virus was shed within 3 to 6 days postinfection, mainly via the respiratory tract. Viral antigen was detected in 100% of the succumbed birds, particularly in the central nervous system. In blackcaps, the heart, lungs, and pancreas were mainly infected. In contrast, the pancreas was predominantly affected in queleas, whereas the heart and the lower respiratory tract were of minor relevance. The authors hypothesize that neurotropism should be considered a main factor for the fatal course of disease in Passeriformes after infection with HPAIV.

Enhanced testosterone levels affect singing motivation but not song structure and amplitude in Bengalese finches

Song is a fundamental component of territory defense and mate attraction in birds, and androgens (like testosterone) are known to play a key role in controlling it. However, little is known about how differences in testosterone levels between males translate into inter-individual song variation. Indeed, testosterone could affect both the motivation to sing and the structure of song itself. Here, we tested whether experimentally elevated testosterone levels in adult Bengalese finches (Lonchura striata var. domestica), an oscine bird species, have an activational effect on 1) song performance, and 2) song structure. Our results show that testosterone-treated males, in contrast to sham-control males, sang more when confronted with a female. Other performance-related traits, however, such as latency to sing and song amplitude, were not affected. Testosterone-treated males also showed no differences in our two measures of song structure: fundamental element frequency and mean song frequency. Because song structure is known to be organizationally affected by testosterone, our results, synthesized together with findings from the current literature, suggest that in oscine birds, song contains multiple messages about the signaler's hormonal status. First, song performance may reflect current hormonal condition, and second, song structure may reflect the past hormonal state.

Fasting plasma glucose is not sufficient to detect ongoing glucose intolerance after pregnancy complicated by gestational diabetes

AIMS

Women who develop diabetes during pregnancy are at significant risk of developing Type 2 diabetes later in life, and "should be offered blood glucose testing ... to exclude persisting hyperglycaemia" after delivery. New UK guidelines now recommend that this is done by measurement of fasting blood glucose, rather than an oral glucose tolerance test (OGTT). Our study aims to establish whether assessment by fasting blood glucose gives equivalent results to an OGTT.

METHODS

Retrospective data were obtained from four centres in the West Midlands, UK, who performed a postnatal OGTT on 470 women during a 12-month period. All centres used a 75 g, 2-h protocol.

RESULTS

28 of 470 (6.0%) women had diabetes mellitus after testing of fasting plasma glucose. After OGTT, 70 women (14.9%) were found to have impaired glucose tolerance (IGT), and 10 further cases of diabetes were detected (overall prevalence of DM 8.1%). Of the 400 women with normal fasting plasma glucose. After OGTT, 70 women (14.9%) were found to have impaired glucose tolerance (IGT), and 10 further cases of diabetes were detected (overall prevalence of DM 8.1%). Of the 400 women with normal fasting plasma glucose (< or = 6.0 mmol/l), 55 were found to have impaired glucose tolerance and 4 had overt diabetes. In all, 26% of women with diabetes were missed by FPG.

CONCLUSION

Fasting plasma glucose alone does not allow detection of IGT, and misses a substantial proportion of women with Type 2 diabetes. Recognition of ongoing IGT or DM is important in identifying women who may benefit from lifestyle modification, and who may need early intervention in subsequent pregnancies. Our results suggest that OGTT should be the investigation of choice in the postnatal assessment of women who have had GDM.

Emergency nurse practitioners and doctors consulting with patients in an emergency department: a comparison of communication skills and satisfaction

BACKGROUND

Emergency nurse practitioners (ENPs) play an increasingly important role in UK emergency departments (EDs), but there is limited evidence about how this affects patient care and outcome. A study was undertaken to compare the content of, and satisfaction with, consultations made with patients presenting with problems of low acuity to an ED.

METHODS

Patients presenting with "primary care" problems were allocated to senior house officers (SHOs, n = 10), specialist registrars/staff grades (n = 7), sessionally-employed general practitioners (GPs, n = 12) or ENPs (n = 6) randomly rostered to work in a consulting room that had a wall-mounted video camera. At the end of each consultation the doctor/ENP and the patient were asked to complete the Physician/Patient Satisfaction Questionnaire. A stratified sample of videotaped consultations (n = 296) was analysed in depth using the Roter Interaction Analysis System. The main outcome measures were length of consultation; numbers of utterances of doctor/ENP and patient talk related to building a relationship, data gathering, activating/partnering, and patient education/counselling; doctor/ENP and patient consultation satisfaction scores.

RESULTS

ENPs and GPs focused more on patient education and counselling about the medical condition or therapeutic regimen than did ED doctors. There were no significant differences in consultation length. ENPs had higher levels of overall self-satisfaction with their consultations than ED doctors. Patient satisfaction with how actively they participated in the consultation was significantly associated with the amount of talk relating to building a relationship and activating and partnering, and patient satisfaction with information giving in the consultation was significantly associated with the amount of talk relating to building a relationship.

CONCLUSION

These findings suggest differences between ENP and ED doctor consultations which are associated with some aspects of patient satisfaction. In contrast to previous reports, consultation length was not greater for ENPs than for doctors. There is a need for further research to test the generalisability of these findings and their impact on clinical outcome.

A national facilitation project to improve primary palliative care: impact of the Gold Standards Framework on process and self-ratings of quality

BACKGROUND

Improving quality of end-of-life care is a key driver of UK policy. The Gold Standards Framework (GSF) for Palliative Care aims to strengthen primary palliative care through facilitating implementation of systematic clinical and organisational processes.

OBJECTIVES

To describe the general practices that participated in the GSF programme in 2003-5 and the changes in process and perception of quality that occurred in the year following entry into the programme, and to identify factors associated with the extent of change.

METHODS

Participating practices completed a questionnaire at baseline and another approximately 12 months later. Data were derived from categorical questions about the implementation of 35 organisational and clinical processes, and self-rated assessments of quality, associated with palliative care provision.

PARTICIPANTS

1305 practices (total registered population almost 10 million). Follow-up questionnaire completed by 955 (73.2%) practices (after mean (SD) 12.8 (2.8) months; median 13 months).

FINDINGS

Mean increase in total number of processes implemented (maximum = 35) was 9.6 (95% CI 9.0 to 10.2; p<0.001; baseline: 15.7 (SD 6.4), follow-up: 25.2 (SD 5.2)). Extent of change was largest for practices with low baseline scores. Aspects of process related to coordination and communication showed the greatest change. All dimensions of quality improved following GSF implementation; change was highest for the "quality of palliative care for cancer patients" and "confidence in assessing, recording and addressing the physical and psychosocial areas of patient care".

CONCLUSION

Implementation of the GSF seems to have resulted in substantial improvements in process and quality of palliative care. Further research is required of the extent to which this has enhanced care (physical, practical and psychological outcomes) for patients and carers.

Effects of timolol on platelets in coronary sinus blood and on myocardial ischemia during pacing-induced angina

The effect of timolol on blood platelet function was studied in coronary sinus and caval vein blood at rest and during pacing-induced angina in 20 patients with coronary heart disease. During pacing-induced angina, lactate measurements confirmed that coronary sinus blood was sampled from ischemic regions in 13 men. The ischemia did not influence platelet function. In blood from non-ischemic myocardium, platelet activation was found during pacing: the ADP-induced aggregation, platelet retention and plasma beta-thromboglobulin levels increased moderately but significantly. Timolol administration prevented this platelet activation, possibly by inhibiting catecholamine release from the myocardium, and reduced the ischemic response during pacing as judged from lactate measurements and ST depressions. It is concluded that timolol reduced platelet activation induced in non-ischemic regions of the heart during tachycardia stress as well as myocardial ischemia.

Can acetylsalicylic acid alone prevent arterial thromboembolism? A pilot study in patients with aortic ball valve prostheses

Encouraged by the effective prevention of arterial thromboembolism with a combination of ASA and anticoagulants (9), the present study was done in 77 patients with a single Starr-Edwards aortic ball valve. They received one gm. of ASA daily, then the dose of anticoagulants was reduced gradually and the drug discontinued on average five weeks later. Six arterial embolic episodes occurred in five patients, the incidence being 14.5 complications per 100 patients per year. Five emboli were cerebral, none of them serious, and one was removed from a femoral artery. Four of the embolic episodes occurred in three of the 11 patients with continuous arrhythmia, probably from venus thrombi that developed in the left atrium. The occurrence of only two embolic complications in the 66 patients with sinus rhythm suggests some prevention of arterial thrombus formation on the prosthetic valves. The results indicate that ASA is inferior to anticoagulants in patients with arrhythmia, while it may represent an alternative to anticoagulation in individuals with sinus rhythm. We prefer, however, the combined therapy in patients with aortic valve prostheses because of the strong anti-thrombotic effect achieved by this treatment.

Effect of very early intravenous streptokinase infusion in patients with evolving myocardial infarction

The effect of very early infusion of 1.5 X 10(6) U of streptokinase intravenously was studied in 29 patients with nitroglycerin-resistant chest pain and ST-segment elevation. Infarct size was estimated from maximal LD1 isoenzyme levels, and the diagnosis confirmed by CK-MB determination. Thrombolytic therapy was started within 1 hour of pain onset in 11 patients (group A), between 1 and 2 hours in 10 (group B), and later than 2 hours in eight patients (group C). Marked differences appeared between the groups. Thus, three patients in group A and one patient in group B did not develop infarction, all had critical LAD stenoses. Three patients in group C died in shock without bleeding. Further, the average maximal LD1 values in the 22 patients who survived their infarction differed significantly between the groups, and were 12.6, 19.1 and 36.2 mu kat/l in groups A, B and C, respectively. In conclusion, very early intravenous streptokinase infusion probably reduces myocardial necrosis, and possible prevents infarction in some patients.

Antihypertensive, haemodynamic and metabolic effects of nifedipine slow-release tablets in elderly patients

In a double-blind, cross-over study for 8 weeks, including 10 non-hospitalized elderly hypertensives (average age 73.2 years), WHO stage I-II, the antihypertensive effect of nifedipine slow-release tablets, 20 mg twice daily, was compared with placebo. Nifedipine reduced supine and standing blood pressure values significantly, and no signs of orthostatic hypotension were noted. An initial increment in heart rate was found after 1 week with a subsequent fall towards control values after 8 weeks of nifedipine administration. Heart rate pressure product in the supine position was reduced, and this reduction became statistically significant at the 8th week. Cardiac output measured non-invasively in 8 patients after 6-8 weeks' nifedipine therapy, using an Irex echocardiograph, was on an average 34% higher than in the placebo period (p less than 0.05). Serum electrolytes, cholesterol, HDL cholesterol, blood glucose and renal function were not affected by the drug. Side-effects were few and mild. It is concluded that nifedipine is a potent antihypertensive agent which may represent an attractive first choice alternative in the treatment of elderly hypertensive patients.